Surprised Dr not interested..

[Ron1]

Hi, I only have to press the send button to hopefully begin loosing weight as have filled in the form. I had a few questions for juniper as I have health issues : fatty liver (non alcoholic) removed gall bladder, Hypothyroidism, pre diabetes , acid reflux. They suggested I contact my GP to ensure the medication is appropriate for me. Spoke to GP today, I felt they were quite dismissive said they have no input into the 'private' treatment and its up to the provider to care for my health as they are providing the medication. Wouldn't discuss anything other than tell me my Liver blood results have got better over the last year. Even though I know its double what it should be at 80.0u/L although 3 years ago it was 226. u/L. Why would they have this attitude I wonder, when I am trying to get my health issues under control? I need to loose 3 stone and have plateaued (I have to say they are normally very good so am surprised at the attitude towards this drug)!

Oh it definitely a good idea. NHS love their hoops though.

I'm surprised too OP, especially given that you have some existing health conditions, and as you say, you are trying to improve your health.

I've made an appointment to see my GP to talk about going on Mounjaro, he's very interested in research and keeping up to date with health insights, treatments and developments so I'm hopeful he will be more engaged than your GP.

@DimplyDumpling I would be interested to know how that conversation with your GP goes, if you don't mind updating afterwards. Are you hoping that your GP will prescribe it to you as part of the recent rollout programme?

Unless your gp is prescribing they will not discuss it. My gp has announced that there will privately bookable appointments from later in the year on Saturdays for weight loss meds so I’m waiting for that

I'm not sure that's the case now that things have been tightened up.

If there's something they don't like in the questionnaire, they should do an in-house, on-line consult with the prescribing doctor. They are the doctor who is responsible for the prescription after all. That is part of the service you are paying for privately. This is what happens with mine and they inform my GP.

This is the equivalent of getting a procedure done in Turkey and expecting the NHS to fix things if things go wrong.
I think that the GP having a private Saturday morning surgery for this kind of thing is being smart about the need for this kind of service.

Yes, very happy to update @SilenceInside

No, I’m not hoping he will prescribe it. I am only just eligible (BMI 27) but have been treated for high BP for over a decade and I have high cholesterol. My mother was only 67 when she had her first stroke and I’m just 4 years younger than that so I’ve been wondering whether I should bite the bullet and give Mounjaro a go. I’m aware that GLP1s are thought to protect against strokes.

I had my gallbladder removed years ago and I have hypothyroidism so my thyroid meds might need adjusting if I lose weight. I’ve been trying to get to a healthy BMI for several years but I just can’t seem to get there. I suspect my thyroid condition makes weight loss harder.

I would like the GPs opinion because much as I want to lose weight I don’t have a huge amount to lose and I’m quite anxious about side effects. He may not want to advise me but I thought it was worth a conversation. Anyway, I will let you know!

There’s clearly quite a fundamental lack of understanding on this thread of what Juniper were asking of OP’s GP.

It is one thing for a GP to take a general interest in GLP-1s and to be supportive of a patient who wishes to take them. It is quite another matter to be asked to rubber-stamp the prescribing of a potent medication, with no further involvement or control over the actual administration of the drug. This is what Juniper are asking for.

If MJ exacerbates one of the OP’s existing conditions and the GP has been the one to approve it then I absolutely guarantee that Juniper’s lawyers will deny all responsibility and bounce it straight to the GP, who will find themselves facing career-ending consequences.

Yes, we send a very firm letter to all the private prescribers saying that we're not reviewing the notes for free and they can look at the NHS app or request and pay for a formal medical report and all the liability lies with them.

The NHS 'should' prescribe in line with private prescribers but at the moment they can't due to lack of resources.

The tightening up has mainly been around checking patient’s IDs and confirming their BMI.

By safety I was referring to contraindications and precautions. There are relatively few absolute contraindications to Mounjaro but a number of people such as the OP will have conditions that could affect the way the medicine could work and so prescribers may need additional information.

My point wasn’t just about WLI but about the Government pushing people to use private services when the private sector doesn’t have access to people’s health records.

I think most private providers will prescribe from BMI 30, with no need for a co-morbidity, whereas NICE says BMI 35 (unless a high-risk ethnicity) plus one co-morbidity, so the NHS absolutely shouldn't be copying the private sector.

Make an appointment with a private GP then. Are you really going to waste your NHS GP's time on this with a BMI of 27? Remember your actions next time you can't get an appointment........

I'm so glad that we do phone triage and this wouldn't get past the door.

If it’ helps to set your mind at ease at all, I was obese, with T2 diabetes, no gallbladder, high cholesterol and high blood pressure when I was prescribed Mounjaro back in September last year.

Now I have a BMI of 22, can jog (slowly) 5k without stopping, normal BP and diabetes is in remission. On statins for the cholesterol but it’s back in a normal range so there has been improvement.

Never had any side effects except feeling the cold but I’m no longer wearing a perma-layer of fatty insulation so that is to be expected.

Weightloss Injections are licensed for people with a BMI of 30 or 27/28 with at least one comorbidity. The licence is based on proven clinical trials and safety profiles.

NICE recommendations for NHS treatment take into account the cost effectiveness of the treatments. The higher requirements for NHS patients are to do with cost, not safety.

In an ideal world, the NHS would indeed prescribe inline with the product licensing, but both the cost of medicines and the associated costs of health professionals time and appointment administration make that prohibitive.

The NHS has to balance all the calls on its money, so no, in an ideal world it wouldn't be prescribing at a level which isn't cost-effective. I'm fully aware how NICE makes its decisions and the NHS should be following its advice - ideally slightly more quickly than 12 years later.......

I know my GP pretty well. I would be very surprised if he considers the appointment a waste of time but given your response I will ask him directly next week.

Fwiw I am fortunate to live in an area where getting GP appointments is actually not that difficult. I was offered two or three sooner than this one but couldn’t go due to other commitments.

Your poor GP. He's unlikely to admit to your face what he really thinks of you....

I think there are a few things here. Really, the prescriber should be able to assess your Suitability.
Secondly, if your NHS GP is giving you advice about this, then it becomes a nit of a grey area of, well you think I can/ should/ it would be beneficial to my health, why aren't your prescribing it?

Also, depending on how long your GP has been practising, they may know very little about the jab itself.

When Saxenda was V V new, I went to my GP about my side affects he said, "I'm sorry, but I don't really have any answers." I did a bit of a Google and said, eat more!

Now I'm on mounjaro, I'm not sure how, but my injection site is infected, my GP wasn't inclined to treat me, it seems.

Lastly, can I just recommend shemed for mounjaro? It's about £150 a month, whatever dosage you have, and they can monitor your progress with your HBA1C, cholesterol, and many other things, plus you get a weekly check-in with them.

As a nurse I was taught to look after my patients holistically. Is that not fundamental to GP training too?

I was expected to do that when I was time poor and under pressure (always).

WLIs are expected to improve health outcomes and reduce NHS spending. The disdain in the way they are talked about here is as though patients are asking for advice on breast implants or Botox.

I totally understand the issues around legal liability discussed, but we also need to consider that people's medical history sits within the NHS as their usual care giver. In many cases people know and trust their GP, I certainly do mine.

Every single user of WLIs would prefer their GP to prescribe them, and that's as much a safety reassurance issue as it is a cost one.

I understand why a GP won't rubber stamp a treatment managed by a private entity (which people are being forced to use), but surely she/he can give some grace to a patient wanting to discuss something that could be so beneficial to their overall health.

1 appointment now could save 10 appointments in the future.

Someone mentioned their surgery opening up private appointments. Seems like a good compromise. You still get to see your GP (whom you trust and who manages your comorbidities), but you pay them.

This would also mean that people who want their GPs advice wouldn't be doing it on a whim. They'd really want to speak to them.

But your GP is not prescribing this drug for you are they?

You’ve chosen to start this medication via a ?private provider- it’s really not up to the GP to give you their blessing/whatever

When did you last work in the NHS? and as someone who may need an appointment from me because you need my expertise in diagnosis, are you happy jot to get it because someone with a BMI of 27 wants to discuss WLI?

Surely there’s enough information online to give you a good idea whether your health issues might conflict with the side effects of the weight loss drugs.
also these drugs won’t want scary headlines of illness due to taking their stuff

I did my last shift in 2024.

I am happy for you to take a bigger picture view of things yes - the 27 BMI patient has high BP, high cholesterol and a family history of stroke.

@JustPinkFinch I’m also a GP. We are not legally allowed to provide private services to our NHS registered patients EXCEPT for issues that are not covered by the NHS to begin with (eg you could technically do a private cosmetic clinic for Botox etc).

We could eg do a private Saturday clinic for people not registered with us as NHS patients but that doesn’t really solve this issue, which as many others have already said is really about private companies wanting us to take on medicolegal responsibility for their prescribing (and take up our appointments), when they need to do their own assessment (we will happily provide patient summaries if requested with pt consent for information, and of course these days at least on most of the UK people can access their own records on the NHS app anyway). So the Saturday morning private clinic idea for us to deal with queries like this from our patients is a non starter unfortunately.

I would largely agree with @bluecurtains14 that despite the other health issues with a BMI of 27 I personally think on current evidence there is likely to be significantly more risk than benefit to this person from weight loss injections. I wouldn’t be totally opposed to having a conversation with a patient in this situation to explain this to them however given the other health issues in the background given they do not (presumably!) have medical training themselves, so what is obvious to us may not be for that person. But as @bluecurtains14 has pointed out all of these sort of queries potentially come at a cost of not being able to provide an appointment for someone in much direr need of our services at a time of seriously high pressure on appointments ever since the pandemic.